Targeting the Premaxillary-Maxillary Suture for Skeletal Class III Correction in Growing Patients: Ertty Gap III Versus Facemask Therapy in a Randomized Clinical Trial
Targeting the Premaxillary-Maxillary Suture for Skeletal Class III Correction in Growing Patients: Ertty Gap III Versus Facemask Therapy in a Randomized Clinical Trial
This clinical study compared two orthopedic treatment approaches for growing patients with skeletal Class III malocclusion associated primarily with maxillary deficiency: the Ertty Gap III appliance and facemask therapy. Participants assigned to active treatment received either Ertty Gap III or facemask therapy, while an untreated historical Class III group was used as a reference for growth-related changes. The main objective was to compare the skeletal effects of the two treatment approaches, particularly changes in the sagittal relationship between the maxilla and mandible. Dentoalveolar, vertical skeletal, and soft tissue changes were also evaluated. Lateral cephalometric radiographs obtained before treatment and after correction of the anterior crossbite and achievement of a positive overjet were used for the assessments.
Inclusion Criteria:
Exclusion Criteria:
Skeletal Class III malocclusion in growing patients may be associated with maxillary deficiency, mandibular prognathism, or a combination of both. Early orthopedic treatment directed toward maxillary advancement is commonly performed using facemask therapy. The Ertty Gap III appliance represents an intraoral approach designed to promote maxillary advancement while applying orthopedic forces through a different biomechanical configuration.
This single-center clinical study was designed to compare the skeletal, dentoalveolar, and soft tissue effects of Ertty Gap III therapy with those of conventional facemask therapy in growing patients with skeletal Class III malocclusion. Participants in the active treatment component were allocated to either the Ertty Gap III group or the facemask group. An untreated historical Class III sample was additionally included as a growth reference to distinguish treatment-related changes from changes associated with natural craniofacial growth.
Standardized lateral cephalometric radiographs were evaluated at baseline (T0) and after treatment or observation (T1). In the active treatment groups, T1 records were obtained following correction of the anterior crossbite and achievement of a positive overjet. The primary outcome was the change in the A point-Nasion-B point (ANB) angle from T0 to T1. Additional cephalometric measurements were used to evaluate sagittal and vertical skeletal relationships, dentoalveolar changes, and soft tissue profile changes.